上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 24 Auscultation

Physical examination f the chest(2 郑翠霞

Physical examination of the chest(2) 郑翠霞

Auscultation Normal breath sound vesicular breath sound bronchial breath sound bronchovesicular breath sound

Auscultation ◼ Normal breath sound ◼ vesicular breath sound ◼ bronchial breath sound ◼ bronchovescicular breath sound

Abnormal breath sound Decreased or absent Lower breathing Increased alveolar breath sound EXert your breathing

Abnormal breath sound ◼Decreased or absent ◼Increased alveolar breath sound J: Lower breathing J: Exert your breathing

Adventitious sounds fine Discontinuous Rale/ crackes coarse wheezes Contnuous Dry/ rhonchi rhonchus

Adventitious sounds Discontnuous Contnuous fine coarse wheezes rhonchus Dry/ rhonchi Rale/ crackes

.Adventitious sound coracles fine mediate rough moist rale( crackles) ∧ rhonchi Vocal resonance b b eural rubber Ing. crepitus

•moist rale( crackles) • Rhonchi • Vocal resonance • pleural rubbing : crepitus •Adventitious sound

Table 5.3 Clinical Conditions and Timing of Crackles Early Crackles Late Crackles Chronic bronchitis Diffuse interstitial fibrosis Asthma Airspace pneumonia Emphysema Pulmonary congestion and edema Atelectatic crackles" Sarcoidosis Bronchopneumonia Scleroderma Rheumatoid lung Asbestosis

Extra-pulmonary sign Central C cyanoSis peripheral Clubbing fingers Paraneoplastic syndrone

Extra-pulmonary sign •Cyanosis: •Clubbing fingers: •Paraneoplastic syndrones: Central peripheral

Lobe pneumonia Cough, chest pain, dyspnea Consolidation signs, pleural fremitus WBC个个, olobel infiltration on chest film

Lobe pneumonia •Cough, chest pain, dyspnea •Consolidation signs, • pleural fremitus •WBC, •lobel infiltration on chest film

Bronchial asthma short of breat .Over inflation e wheeze, dyspnea OEOS chest film and sputum changes

Bronchial Asthma •short of breath •Over inflation •wheeze, dyspnea •EOS  •chest film and sputum changes

emphysema increasing onset of exertional dyspnea Barrel chest, prolonged expiration, decreased or diminution breath sound X-ray: over inflation, flatten diaphragm, drip like heart Respiration function: obstructive abnormality with increased RV(40%TLC

emphysema •Increasing onset of exertional dyspnea •Barrel chest, prolonged expiration, decreased or diminution breath sound •X-ray: over inflation, flatten diaphragm, drip like heart. •Respiration function: obstructive abnormality with increased RV(>40%TLC)